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The Emotional Impact of Infertility & IVF · PDF fileThe Emotional Impact of Infertility & IVF...
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Transcript of The Emotional Impact of Infertility & IVF · PDF fileThe Emotional Impact of Infertility & IVF...
![Page 1: The Emotional Impact of Infertility & IVF · PDF fileThe Emotional Impact of Infertility & IVF ... • Made friends . Leah ... •Meta-analysis undertaken in 2010 showed that emotional](https://reader031.fdocuments.us/reader031/viewer/2022022005/5ab86d157f8b9ac1058cab12/html5/thumbnails/1.jpg)
The Emotional Impact of
Infertility & IVF
Marianne Tome
Counselling Manager
Melbourne IVF
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Overview:
• Impact of infertility/treatment on individuals and couples
• Case egs
• Male experience
• Some stats and figures
• Role of counselling
• More serious reactions
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Kate and James
• In their mid 30s, married for 3 years, ttc for 1
year
• Unexplained infertility
• 1 stim cycle – 3 embryos - unsuccessful
• Attend supportive counselling appointment
to prepare for next stim cycle
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Kate:
• High level of anxiety about treatment - doubtful
IVF will work, frustrated with what she
perceives as her ‘failure’
• Frustrated/upset that James does not appear
concerned/upset enough about their situation
• Struggles with treatment – moody, teary,
anxious, feels all control has been taken from
her
• Has not found James a good support - feels he
withdraws from her when she is too emotional
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James:
• Described self as optimistic about treatment and pleased
that they are doing something positive after months of
uncertainty
• Found first cycle very difficult as did not know how to help
Kate
• Found anything he said/did antagonised Kate – admits he
withdrew to avoid conflict
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Counselling Intervention
- 1st time James had spoken about his
experience during treatment
- Kate had seen James’ withdrawal as
uncaring rather than not knowing what to
do/avoiding conflict
- Discussed what they had learnt about
themselves/each other during treatment –
first major stress they have experienced as a
couple
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Counselling intervention
• Discussed plan for next cycle
• Mindfulness techniques for Kate
• Couple attended 2 more counselling sessions
• Undertook 2 more cycles
• Couple described feeling much more in sync
with each other and more of a team.
• Currently pregnant
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Leah:
• 32 year old, 2 rounds of unsuccessful
treatment (1 embryo per cycle)
• Had stopped treatment
• ‘ I had lost my sense of peace, calmness,
hope and also my courage to give IVF
another go anytime soon’
• Joined Melbourne IVF’s Mindfulness Group
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Leah:
• Learnt:
• How to identify unhelpful thoughts
• Mindful meditation
• Relaxation exercises
• Techniques for sleeping better
• How to manage stressful situations
• Made friends
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Leah
• Leah practising a
mindfulness exercise
prior to laparoscopy
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Leah:
• Outcome:
• Described feeling more hopeful, optimistic, calmer and less worried thoughts
• Commenced treatment again
• Not pregnant but continues to practice the techniques she learnt and experience the gains she made through the Mindfulness program and this has allowed her to continue with treatment
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Impact of infertility/ART:
• Studies have shown that stress from
infertility similar to those with ca (Domar)
• Depression and anxiety highly prevalent
amongst women undertaking ART
• Study of 42000 IVF patients – 60% met criteria
for depression following a failed cycle
(Sejbaek)
• Treatment can cause depression (de Klerk)
• Milder treatment, fewer symptoms of depression
• 40% of women met criteria for psych
disorder at 1st infertility evaluation Chen et al
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Impact of Psychological Factors on
ART
• Studies have showed mixed results regarding the influence of stress and distress on ART outcomes.
• Meta-analysis undertaken in 2010 showed that emotional distress (depression/anxiety) will not compromise the chance of becoming pregnant (J. Boivin)
• However emotional distress as a result of infertility/IVF treatment may reduce patients willingness to remain in treatment for the optimal number of cycles to fall pregnant (J. Boivin)
• Women with depression dx prior to ART underwent significantly fewer cycles (A. Domar)
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What helps – Cognitive restructuring
• CBT (cognitive behavioural therapy)
• Exploring negative/unhelpful thoughts
• Does this thought contribute to stress?
• Where did I learn this thought?
• Is it logical?
• Is it true?
• Finding new ways of thinking about treatment
and self
• ACT (Acceptance and Commitment Therapy)
• Package of tasks during cycle
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What helps – Mindfulness techniques
• Being aware of experiences with openness, receptiveness and interest rather than avoidance/judgement/controlling
• Engaging in the present
• Can increase enjoyment of life/reduce distress/enhance relationships
• Breathing/Relaxation techniques
• Yoga
• Writing techniques
• Exercise/physical activity
• Mindfulness apps
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More serious reactions
• Major Depressive disorder
• Anxiety disorders
• Exacerbation of previous psychiatric issues
• PTSD
• Schizo-affective disorder
• Bi-polar
• Suicidal thoughts/behaviour
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Joanne
• 40 year old single woman accessing treatment with CRSD
• No significant issues identified through counselling although
socially isolated and no previous long term relationships
• Denied any mental health history
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Joanne
• Commenced treatment
• Staff noticed that she was calling frequently, highly anxious,
not able to retain information
• Behaviour escalated and staff contacted counselling –
conversations irrational and she became abusive towards
staff, not following instructions
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Joanne
• FS decided to stop treatment and await assessment
• Joanne refused assessment
• Treatment did not continue
• Joanne went to another clinic
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Joanne:
• Significant proportion of patients who start treatment have a
pre-existing mental health history
• More vulnerable to the stress of treatment
• May present ok initially
• Thorough pre-treatment assessment essential
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More serious reactions
• Liaison with mental health professionals
• Plan in place
• Monitoring of patients and reporting any
concerns
• Earlier intervention the better
• Prevention better than cure!
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Let’s end with a good news story